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How other communities solve health care problems

As experts will tell you, even if the reasons for the doctor shortage afflicting the Northeast can be diagnosed easily, the treatment won’t be as simple. They can say that because the disease is not unique to the region by any means.
The doctor shortage in Fort St. John isn't necessarily a unique problem.

As experts will tell you, even if the reasons for the doctor shortage afflicting the Northeast can be diagnosed easily, the treatment won’t be as simple.

They can say that because the disease is not unique to the region by any means. Physician recruiters in both Alberta and Saskatchewan have said that there are rural communities in both of their provinces that are facing these types of shortages.

David Kay, the Executive Director of the Rural Physician Action Plan, which aims to bring doctors to rural Alberta, said that there are communities within his province that are facing these shortages.

As one example, he pointed to Grande Prairie, the nearest big city neighbour to Fort St. John, Dawson Creek and Fort Nelson.

“(Grande Prairie is) a community where the physicians and healthcare workers generally work well together,” he said. “It’s a community that thinks about recruitment and retention.”

Meanwhile, in Fort St. John, numbers appear to have improved slightly in recent weeks but the city’s health system is still very short. According to a recent Northern Health release, there are currently 24 general physicians in Fort St. John; the province’s plan says that the region should have 30 doctors.

Kay said he’s seen some places that managed to get out of this situation, but the path wasn’t easy.

“It’s really local physicians, local healthcare workers and the community working together,” he said. “It sounds simple, but it’s not ... it’s a lot of hard slugging.”

Communities also need to be “realistic” about their healthcare services, Kay added.

“Eating well, not smoking, simple stuff ... that’s the things you can do to reduce the burden on the healthcare system until you need it,” he said.

On a recent petition about healthcare, one signer said that authorities should “pay (the doctors) what they want” to bring them in.

But according to Kay, more money won’t solve the problem, and some of his counterparts in B.C. agree.

In March, the province announced that it would give $100,000 to doctors who came to practice in rural areas. Then, in December, officials announced that only nine doctors had taken the offer.

“Recruiting a city doctor to work in a smaller community is unlikely to happen unless that doctor has a reason for making a change,” said Sharon Shore, a communications manager for Doctors of B.C. “This is one reason why the $100,000 incentive program has not worked as well as we had hoped.  You can’t entice people with money if their heart lies somewhere else.”

Jordan Winkler, a communications manager for the Physician Recruitment Agency of Saskatchewan, agreed that money won’t solve everything.

“It may get a doctor, some of those incentives, but it doesn’t keep them there,” he said. “They get a doctor to a community and a practice but soon that doctor moves on to something that they didn’t have in mind, or something bigger and better ... there’s no one-size-fits-all solution.”

However, Winkler did point out that some Saskatchewan communities have had success in bringing doctors in. The city of Weyburn, for instance, brought in its Chamber of Commerce to help.

“It helped the city of Weyburn out with a welcoming type of event to including the new physicians and their families in community events and incorporating them,” he said.

But part of the difficulty is that doctors aren’t autonomous units, said Jordan Hiltunen, a spokesman for the Wood Buffalo Primary Care Network, which serves Fort McMurray.

“It may be the right fit for the doctor, but it may not be the right fit for the (doctor’s) family,” said Hiltunen, who agreed that family balance was important to bring in and keep doctors.

Fort McMurray is similar to Fort St. John in that both are towns that are developing because of a resource boom. But according to Hiltunen, Fort McMurray does not face a doctor shortage.

Hiltunen said that part of the reason for Fort Mac’s success in attracting doctors is that his community had a reputation for being “very family-friendly.”

There are also differences between where he practices and others that he said may help.

“As a former resident of B.C., I’m somewhat surprised looking back in retrospect that there’s not the same emphasis on comprehensive, team-based care (in B.C. than Alberta),” he said.

In some cases, his Primary Care Network helps pair doctors and other specialists to lessen the sense of isolation, which can help keep younger doctors away, according to Melanie Bechard, vice-president of government affairs for the Canadian Federation of Medical Students and a medical student herself. 

“A lot of times in rural areas, you won’t have additional staff in your office. You won’t have additional doctors who can cover for you, or if you become ill,” she said, although, she said that anecdotally, “I’ve heard that there’s a lot of satisfaction in rural British Columbia.”

Bechard said that it can fall into a pattern where a doctor can become burned out if they feel overburdened, which may cause them to leave, a situation that may repeat over and over again through multiple doctors.

Her group has pushed for governments to offer debt forgiveness incentives earlier, before doctors’ medical residencies are completed. During residency, which takes place immediately after graduating medical school, students earn less than they would as a full doctor, and debt forgiveness in this stage could make it more appealing for young residents to head north.

Communities in Ontario have also helped come up with ways to smooth doctor recruitment.

Dr. Granger Avery, the executive director of the Rural Coordination Centre of B.C., said that in the town of Marathon, Ontario, they asked a new doctor to bring over fellow doctors who were friends of the original recruit – which helped the town keep that new doctor.

Granger said neighbouring communities were also teaming up to attract doctors, and other places were relying on nurse practitioners, who often have credentials to diagnose illness and prescribe medication like a doctor would.

However, even with all these factors, there are still some issues that northern B.C. has to face. “It’s more expensive to run a business here because you have to pay staff more, your rent is higher, space is limited,” said Dr. Charl Badenhorst, Northern Health’s medical health officer for northeast B.C. “To live in the North, it’s more expensive than it is otherwise. We have to compete with physicians that can work somewhere else with lower overhead.”

The price of a house – averaging around $400,000, according to the most recent numbers from the B.C. Northern Real Estate Board – can also complicate matters.

“That, plus daycare, takes a big chunk of your paycheck,” Badenhorst added. “It’s difficult to compete with other communities that accommodate and offer a better deal for doctors.”

Some communities, such as Nakusp, have offered to pay for a doctor’s home should they live there. Bechard said that this offer would likely make a place like Fort St. John much more attractive to students such as herself.

“The same thing that would attract the general population would also help attract medical students and physicians,” she said.

Another possible measure to improve physician recruiting, according to Badenhorst, is to change the licensing process for physician processes.

“Since they changed the recruitment process, it becomes difficult to fill that position,” he said.

Either way, Northern Health officials said, the authority knows about the situation.

“We do recognize that there’s ongoing challenges with recruiting staff, both physicians as well as healthcare providers,” said Angela De Smit, Northern Health’s recently appointed chief operating officer for the Northeast. “There will be space available coming up in the medical clinics because we know that there will be some retirements through the medical clinic ... NHA has an aggressive physician recruitment plan – they have dedicated resources to physician recruitment.”

Ronald Chapman, Northern Health’s VP of Medicine, said that bringing in doctors was also an effort involving both the city, Northern Health and the North Peace Division of Family Physicians.

“We hope to continually promote (Fort St. John) through (job website) Healthmatch B.C. and through advertisements, conferences,” said Chapman. “That’s our strategy ... you have to continually fish until you find somebody who that type of environment would appeal to them and hopefully they would be happy there.”